If the feds still relied on paper to publish its rules, then the loud sound you would have heard on Tuesday was the thud of the massive physician payment proposal hitting the floor.

Issued late on July 14 by the Centers for Medicare and Medicaid Services (CMS), the SNF sector’s first reaction was to applaud the proposed rule's fix of a policy error from last year to equalize SNF physician payments to be the same for both long-stay residents and short-stay patients.

Park Place covered the issue last night. See the article and all the details here.

Unlike most CMS proposals, this draft rule gained mainstream media attention, as the Trump team billed it as a refresh of a decades-old physician payment system and a conduit to focus on primary and preventive care rather than treatment after patients become ill.

Titled, “The Calendar Year (CY) 2027 Payment Policies under the Physician Fee Schedule (PFS) and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements,” the proposed rule also covered accountable care organizations (ACOs) and plethora of technical changes aimed at getting more participation in the value-based models issued by CMS.

On that count, Eric Palm, chief growth officer at leading ACO stakeholder, Provider Partners, said the proposed rule is “Medicare moving forward in ditching the 'pay for more visits' mindset and rewarding doctors and LTC for keeping residents healthy. Making it easier to join ACOs and updating how physicians get paid means providers can focus on good care, not just racking up billable services.”

What’s the SNF Impact?

Overall, for SNFs, it will take a little more time to analyze the draft rule (comments due in 60 days), but the sector’s leading trade association has issued its initial take. What follows is from a blog post CMS Issues CY 2027 Medicare Physician Fee Schedule by Daniel Ciolek, the associate vice president of therapy advocacy at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

PFS Payment Rates

CMS has identified that providers able to participate in PFS incentive programs will have a 1.19 percent reduction in their PFS conversion factor in CY 2027, while providers such as SNFs that are not able to participate in PFS incentive programs will have a 1.68 percent reduction in their PFS conversion factor. “CMS attributes these reductions to the statutory update and budget neutrality calculations” Ciolek said.  

Telehealth Policies

CMS reminds providers of congressional extensions of most telehealth flexibilities policies through Dec. 31, 2027; that audio-only telehealth authority is extended through Jan. 1, 2028; and geographic and originating site restrictions remain waived through 2027. CMS proposes new telehealth billing modifiers required by the Consolidated Appropriations Act, 2026. CMS proposes adding several new services to the Medicare Telehealth List, including advance care planning and shared medical appointments, he said. 

PT, OT, or Speech-Language Pathology Policies 

CMS proposes increasing the annual therapy threshold based on the 2.5 percent Medicare Economic Index update. Proposed CY 2027 thresholds are $2,540 for Physical Therapy + Speech-Language Pathology (SLP) combined, and $2,540 for Occupational Therapy. CMS also confirms that the targeted medical review threshold remains $3,000 through CY 2027. 

CMS proposes that several new SLP codes be designated as Always Therapy services. Additionally, CMS proposes a new SLP Healthcare Common Procedure Coding System (HCPCS) code GSLPP for the treatment of speech, language, voice, communication, and/or auditory processing disorders for pediatric patients. 

Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) 

CMS proposes significant guardrails for RPM/RTM by requiring RTM to be limited to established patients, requiring a face-to-face (in-person or telehealth) initiating visit before RPM or RTM begins, and limiting billable services to those furnished by clinical staff employed by the billing practice (effectively prohibiting outsourced third-party monitoring vendors). CMS also proposes revaluing RPM/RTM payments.

Overall, Ciolek said CMS is signaling a broader shift toward simplified, integrated remote monitoring, requesting comment on replacing the current 17 RPM/RTM CPT codes with four bundled HCPCS G-codes.

Medicare Shared Savings Program 

The proposals are intended to encourage greater provider participation in the Medicare Shared Savings Program (MSSP) ACOs through stronger financial incentives and reduced administrative burden. “There are no major proposals specifically targeting SNF payment, SNF quality reporting, or post-acute care within MSSP comparable to prior years' discussions around beneficiary assignment after SNF stays. Most changes are focused on financial methodology, program administration, and quality reporting,” Ciolek said. 

These changes could indirectly strengthen ACO-SNF partnerships by making ACO participation more attractive and reducing administrative complexity, he added.

AHCA/NCAL also applauded the Part A/Part B equalization fix in the draft proposal.

For more details and all of the links to the rule, deadlines for comments, and fact sheets, see the bottom of this press release CMS Proposes Transformational Medicare Reforms to Expand Accountable Care, Modernize Physician Payment, and Shift from Sick Care to Healthcare | CMS.

Comments or questions on this article? Contact Patrick Connole at pconnole@parkplacelive.com.